Neurocritical Care: Increased ICP, Traumatic Brain Injury, and Stroke

Vocabulary flashcards covering core pathophysiology, clinical manifestations, diagnostics, and management concepts for increased intracranial pressure (ICP), traumatic brain injury (TBI), and stroke.

Monro-Kellie doctrine

The principle stating that the adult skull is rigid and occupied by brain tissue, blood, and cerebrospinal fluid (CSF), such that an increase in one component requires compensation by the others.

Cushing's triad

A late clinical sign of increased intracranial pressure and potential brain herniation, consisting of widening pulse pressure, bradycardia, and irregular respirations.

Mannitol

An osmotic diuretic that decreases cerebral edema by drawing water from brain tissue into the bloodstream for renal elimination; must be inspected for crystals prior to administration.

3% normal saline

A hypertonic solution that raises blood osmolality to draw water out of brain cells into the vascular space, typically targeted to a serum sodium level of approximately $145\text{--}160\,\text{mEq/L}$ in treatment.

Vasogenic edema

Cerebral edema resulting from increased capillary permeability that allows fluid to leak into brain tissue, commonly associated with brain tumors and infection.

Cytotoxic edema

Cerebral edema caused by cellular injury or hypoxia that impairs cellular pumps, leading to an abnormal accumulation of sodium and water inside the cells.

Transependymal edema

A form of cerebral edema associated with excess cerebrospinal fluid (CSF), typically occurring in the setting of hydrocephalus or impaired CSF drainage.

Primary brain injury

The initial mechanical damage occurring directly to brain tissue at the exact moment of physical trauma.

Secondary brain injury

Pathological processes evolving after the initial trauma—including hemorrhage, cerebral edema, and increased ICP—that nursing and medical interventions aim to prevent or limit.

Comminuted skull fracture

A type of skull fracture where the affected bone is shattered or broken into multiple distinct fragments.

Basilar skull fracture

A fracture located at the base of the skull, often characterized by dural tears causing CSF leakage from the nose or ear, Raccoon eyes, and Battle sign.

Battle sign

Bruising behind the ear that serves as a late physical manifestation of a basilar skull fracture.

Raccoon eyes

Periorbital ecchymosis appearing as a late sign associated with a basilar skull fracture.

Epidural hematoma

A collection of blood situated between the inner surface of the skull and the dura mater, causing compression and displacement of adjacent brain tissue.

Subdural hematoma

A collection of blood pooling beneath the dura mater and above the arachnoid layer, most frequently resulting from venous bleeding.

Cerebral contusion

A physical bruise located directly on the surface of the brain, associated with notable cerebral edema and the potential to expand into a hematoma.

Concussion

A shaking injury to the brain leading to temporary disruptions in mentation or cognition, frequently accompanied by headache, confusion, dizziness, nausea, and sensory sensitivities.

Diffuse axonal injury

A widespread shearing and stretching lesion affecting neuronal axons throughout the brain, typically caused by severe acceleration-deceleration forces.

Arterial dissection

A structural tear within the wall of an artery (such as the carotid or vertebral arteries) that impairs distal blood flow or forms thrombi; carotid involvement can manifest with neck pain and Horner-type signs.

Ischemic stroke

A form of stroke where occlusion of a cerebral blood vessel halts or reduces oxygenated blood delivery to a specific region of the brain.

Hemorrhagic stroke

A type of stroke resulting from bleeding directly into or surrounding brain structures due to the rupture or compromise of a cerebral blood vessel.

Ischemic penumbra

The viable zone of underperfused, ischemic brain tissue bordering an infarct that has not yet suffered irreversible cellular death.

Transient ischemic attack (TIA)

A temporary bout of stroke-like focal neurological deficits that completely resolves but signals an elevated risk for subsequent completed strokes.

BE FAST

A clinical mnemonic for rapid stroke identification representing Balance, Eyes, Face, Arms, Speech, and Time.

Arteriovenous malformation (AVM)

A congenital vascular anomaly consisting of an abnormal tangle of interconnected arteries and veins lacking a normal intervening capillary bed.

Hemorrhagic transformation

A complication of ischemic stroke characterized by secondary extravasation of blood into the territory of freshly infarcted brain parenchyma.

Agnosia

A neurological condition marked by the inability to recognize, identify, or correctly interpret familiar sensory information despite intact sensory reception.

Homonymous hemianopia

A visual deficit where visual perception is lost in the identical lateral half of the visual field across both eyes.

Apraxia

An impairment in the ability to carry out learned, purposeful, motor movements despite retaining full muscle power and motor function.